Provider Demographics
NPI:1114543774
Name:LITTLE, JAY ZACHARY (LPC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ZACHARY
Last Name:LITTLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212901
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29221
Mailing Address - Country:US
Mailing Address - Phone:803-457-5413
Mailing Address - Fax:
Practice Address - Street 1:2740 DEVINE ST STE 1&2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2412
Practice Address - Country:US
Practice Address - Phone:803-457-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7379101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor